Dermatology in practice - 2016

Comment: The doctor will see you now – on screen!
Neill Hepburn
pp 31-31
The organisation of healthcare and its management never seem to be out of the news. One reorganisation leads to another as we adapt to the changing needs of our patients, advances in available therapies, society’s expectations and the government’s financial constraints.
Dutch health reform: the changing face of dermatology
Robert Damstra and Wim Brunninkhuis
pp 32-34
The Dutch healthcare system is undergoing a tumultuous change. Until now, GPs referred patients to specialists, who then took over. Under the new health reform, GPs will have responsibility for patient care, while hospital specialists will provide support and advice to GPs without forming a traditional doctor–patient relationship. This will give patients free access to specialist expertise in the local community. We examine the new Dutch healthcare model and how it affects dermatology.
Vitiligo: clinical aspects and management update
Michelle Rodrigues
pp 36-42
Vitiligo is a chronic, acquired, autoimmune depigmenting skin condition that presents with well-demarcated, non-scaly, symmetrical white macules on the skin, mucous membranes and hair. It affects up to 2% of the world’s population, with equal numbers in males and females. Nearly 25% of those affected are children, and about 50% of patients present before the age of 20.
Psoriasis: severity does not determine quality of life
C Elise Kleyn and Susan Moschogianis
pp 44-46
The clinical challenge posed by psoriasis is much greater than just skin manifestations. In addition to the physical burden of the disease and the co-morbidities linked to it, psoriasis is associated with substantial psychological morbidity, including poor self-esteem and an increased prevalence of anxiety and depression. The practical aspects of living with psoriasis can cause stress and significant disruption to patients’ daily routines. Patients often feel stigmatised and report negative reactions from others, including staring and reactions of disgust. Such experiences, along with the anticipation of further stigmatisation, are likely to contribute to the distress faced by patients and may lead to them avoiding social situations. In one study, 84% of psoriasis patients stated that it was difficult for them to establish social relationships. The substantial negative impact of psoriasis on an individual’s quality of life (QoL) is, therefore, comparable to that of other major conditions, including cancer and heart disease.
Community-based surgery audit: encouraging findings from a two-year pilot
Jonathan P Botting
pp 47-49
To be a GP with a specialist interest (GPwSI) in dermatology, you need the knowledge (if not the depth of experience) of a dermatologist, because you never know what clinical cases you may have to deal with.
Cellulitis: correct diagnosis and treatment of red legs
Linda Nazarko
pp 40-53
The number of people admitted to hospital with cellulitis increased by 88% between 2003 and 2012. The 2015 fall in admissions may be explained by the increased number of patients treated at home. Currently, up to 33% of cases thought to be cellulitis are misdiagnosed. Venous eczema, lympho-oedema and lipodermatosclerosis make up around half of the conditions wrongly diagnosed as cellulitis. This article offers guidance on how to differentiate between various causes of red legs using an evidence-based approach to diagnosis and treatment.
Handbook of Systemic Drug Treatment in Dermatology, 2nd edn
Neill Hepburn
pp 54-54
The first edition of this little book made my life so much easier! In just 300 pages, it dispenses succinct and practical advice on how to prescribe the various systemic agents used in dermatology. In my training days (25 years ago) it was quite hard to know how to monitor drugs. While it has become much easier with the plethora of guidelines and the internet, this little handbook saves a lot of time, and I feel confident following its recommendations.
Primary Care Dermatology Society
Stephen Kownacki
pp 54-54
The PCDS is grateful for the opportunity to publicise our society’s ever-increasing activities, and to flag up matters affecting the dermatological community to a wider audience. Although our membership is restricted to GPs and those eligible to be a GP, we also offer free membership to GP registrars and welcome any healthcare workers to our meetings.
Just like that ...
Barry Monk
pp 55-55
NHS doctors are becoming increasingly frustrated for all sorts of reasons. For one, many feel that they and their managers are working in parallel universes. What matters to us, doctors, all too often doesn’t seem to concern them at all, and what gets them stressed often doesn’t bother us one jot. For example, as doctors, we have no concept as to why it matters whether someone is discharged from A&E within three hours 59 minutes (terribly good) or four hours and one minute (disastrous); or whether a 93-year-old patient with advanced dementia referred by their GP with asymptomatic skin lesions that have been slowly growing for the past 20 years is seen within 14 days (marvellous) or after 15 days (catastrophic).